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Summary:
Etta is tired of dealing with all of the labels and categories that seem so important to everyone else in her small Nebraska hometown.

Everywhere she turns, someone feels she’s too fringe for the fringe. Not gay enough for the Dykes, her ex-clique, thanks to a recent relationship with a boy; not tiny and white enough for ballet, her first passion; and not sick enough to look anorexic (partially thanks to recovery). Etta doesn’t fit anywhere— until she meets Bianca, the straight, white, Christian, and seriously sick girl in Etta’s therapy group. Both girls are auditioning for Brentwood, a prestigious New York theater academy that is so not Nebraska. Bianca seems like Etta’s salvation, but how can Etta be saved by a girl who needs saving herself?

Review:
Etta is a character I wish I had been able to find in fiction when I was a teenager. She’s unashamedly herself, even when it hurts or it involves some floundering. She’s from a small town with dreams of the big city. She just doesn’t fit in her small town. She is so very real because she is so many intersectional elements at once. Most important to me is that she’s bisexual (and she actually SAYS the word), but she’s also female, black, and suffering from Eating Disorder Not Otherwise Specified (EDNOs), where the name of the book comes from.

What’s so great though is that, even with being all of these things, her main point of conflict actually has nothing to do with any of them. She desperately wants to live in NYC, and she sees a contest to get into a musical theater high school in NYC as just the chance to do that. She has a huge dream, and that is something any YA reader can relate to. So even if the reader happens to not relate to Etta on anything else (and honestly, who cares? kids like Etta have to reach really hard to relate to most of the literature out there so it’s about time the mainstream kids have to as well), but even if they don’t relate to her on anything else, they should be able to relate to her on this adolescent experience of The Big Dream.

I loved that Etta is allowed to be the person she is without speaking for All Bisexuals™. She very clearly presents herself as a bisexual person who is not representative of all bisexual people beyond the being attracted to more than one gender thing. I also appreciated that the complexity of the queer community is shown. Etta talks about being pushed into being an outsider by both the straights and the lesbians because both of them kind of just want her to “pick a side.” The book begins with the lesbians being angry at Etta for dating a boy. They’re acting like she was a “fake lesbian,” and this is how Etta feels about that:

And bi the way, I was never a lesbian, and I told the Dykes that all the time, but there isn’t a Banjo Bisexuals group or whatever. (location 54)

While a lot of the book eloquently deals with Etta’s sexuality, it also takes time to talk about race and racism. I lost the highlighted passage but essentially Etta is talking with a friend and discusses how hard it is to be part of so many minority groups and how she can never hide being black but she can hide being queer, and how that means she can never escape racism. On the other hand, she also points out how exhausting it can be to constantly be reminding people of her queerness. No one denies that she’s black but people keep trying to take her bisexual identity from her. It’s a non-preachy passage that introduces the complexities of intersexuality to a YA audience.

Finally, there’s the EDNOS. The best part about this is the book come in when Etta is in recovery. Most books about eating disorders come in during the downward spiral, but Etta has already gone to treatment and is working in recovery. We so often don’t get to see recovery and how messy it can be in literature, but we see it here. We get to see how mental illnesses don’t just go away, people just have strategies for staying in recovery.

There’s a ton that’s good about this book, but I must say that I did think the level of partying could sometimes be a bit over the top. While obviously not all kids are straight-edged I was a bit skeptical of the level of partying going on in Small Town USA (including high schoolers getting into a gay bar repeatedly). Perhaps what struck me as a bit less realitic, actually, was Etta’s intelligent and put-together mother who is clearly caring being somehow out of touch about the partying going on, whereas Etta’s sister is 100% aware. It wasn’t enough to truly bother me and I do think on some level some YA readers expect an unrealistic set of partying situations just for the interest level but in a book that had so much realistic about it, it just struck me as a bit out of place.

Overall, this is a great addition to contemporary YA with an out and proud main character and a timeless plot of a small town girl with big dreams. I requested it at my library to be added to the collection (and they did!), and if you can’t buy it yourself, I highly recommend you doing so as well. It bring so much different to the YA table.

Summary:
Alex fights a daily battle to figure out the difference between reality and delusion. Armed with a take-no-prisoners attitude, her camera, a Magic 8-Ball, and her only ally (her little sister), Alex wages a war against her schizophrenia, determined to stay sane long enough to get into college. She’s pretty optimistic about her chances until classes begin, and she runs into Miles. Didn’t she imagine him? Before she knows it, Alex is making friends, going to parties, falling in love, and experiencing all the usual rites of passage for teenagers. But Alex is used to being crazy. She’s not prepared for normal.

Review:
A YA book featuring a main character with schizophrenia has a lot of potential — both to be great and to go awry. While Alex is always written with empathy, something I appreciated, I ultimately found other elements of the story to be too detracting for me to be able to wholeheartedly recommend it.

Alex, her battle with schizophrenia, and her parents’ attempts yet simulatneous inability to really deal with it fully, are all depicted well in this story. While I think the plot comes dangerously close to making Alex’s parents look like bad guys, ultimately enough other perspectives are shown that it does appear more like a mistake on their part, and a consequence of dealing with such a serious illness and situations for such a long time, rather than something truly mean-spirited or cruel. Alex has enough of a grip on reality to be relatable, while her struggles with aspects of her mental illness are heart-breakingly represented. So why so few stars?

First, while it may be part of her delusions, it’s never made clear if Miles’ grandfather was actually alive during WWII. Alex takes it as fact, and it’s not one that’s ever disputed the way others are. It’s a real stretch for someone Miles’s age to have a grandparent who was alive in WWII as anything other than a baby (and even then, that’s a stretch), particularly since this grandfather is through his maternal line, and women have less of a window in which to have children than men do. It may seem like a small issue, but it’s something that really bugged me. I’m ok with it if it’s ultimately part of one of Alex’s delusions but I do think that should be made clear somewhere in the book.

I also didn’t like the entire plot surrounding Miles’s mother. Essentially, his father falsely convinces the authorities that she’s crazy so that she’ll get locked up in a mental institution and not be able to leave her abusive marriage with her son. The fact that she’s been locked up for years and no one has noticed is just not something I believe could happen in this day and age. The initial mental health screening? Yes. A sane woman remaining in an institution for years against her will? No. It’s clearly established that this is a real thing that happens, not one of Alex’s delusions, and it just had me rolling my eyes.

The ending struck a sour note for me as well. Without giving anything away, Alex is presented as a strong young woman battling an equally strong illness and in the end she kind of just loses her gumption. While I think accepting help is good, the way she accepts it and the way she graduates from it both rubbed me the wrong way. I’m not sure about the message it’s sending to the YA audience.

So while I really appreciate the character of Alex and seeing schizophrenia represented to realistically and while the plot did keep me reading, enough sour notes were hit for me that I ultimately just found it to be an average read.

Summary:
“It’s such a savage thing to lose your memory, but the crazy thing is, it doesn’t hurt one bit. A blackout doesn’t sting, or stab, or leave a scar when it robs you. Close your eyes and open them again. That’s what a blackout feels like.”

For years Sarah Hepola ignored her blackouts. She was a young woman with a successful writing career living in New York City. She was empowered, and part of embracing equality was drinking like one of the guys. But while littering her writing with references to drinking and laughing off her drunken escapades, she actually spent her daytimes cleaning up after her blackouts. Figuring out how she scraped up her knees or tracking down her purse. Eventually, she realized that drinking wasn’t making her the life of the party and one of the guys. It was stealing who she was, and it was time to get herself back.

Review:
I have a thing for addiction memoirs (and addiction documentaries….movies…tv shows…). But I have often found myself puzzled by the female drinking memoir. Often presented as a woman (usually a wife and mother) who appears to have it all and hides all of her drinking because women don’t drink. I’m sorry, but as a Millennial, that’s not the kind of drinking I’ve seen women in my generation partake in. Drinking was considered unladylike by generations even as recent as the one right before ours (that my brother is in). But in mine? What I often saw was women proving their coolness by keeping up with the guys. These women would never hide wine. They’d take shots and get praised for it. So when I saw this memoir talking about the impact on women of drinking like one of the guys; of how this equality of substance abuse is really impacting women, I had a sense it was going to be something good and insightful, and I was right.

Sarah Hepola shows the reader through a clear lens exactly how the different perceptions of women and alcohol impacted her drinking, and thus how they might impact other women. The book starts with some context of how young women are both encouraged by their peers to binge drink but then are also blamed by them when bad things happen to them when they are drunk. She then moves on to talking about her own childhood when she would steal sips of beer from open cans in the fridge, and how her parents never suspected she was sneaking beer because little girls wouldn’t do that. She then gradually brings us up through time and shows us how with drinking she was subconsciously trying to pursue both fitting in and equality. She drank to fit in and be cool in college. She drank with co-workers on her male-dominated first job to be one of the guys and get the same networking opportunities they got after work by going out for beers. She liked that it wasn’t necessarily feminine. She liked feeling strong and empowered.

By embracing something that is perceived of by the culture as hyper-masculine, like binge drinking, women are seeking to be taken seriously and viewed as equals. Women do this in other areas too. Just look at power suits or the short haircuts preferred by women in positions of power. Our culture devalues what is perceived of as feminine and elevates what is perceived of as masculine. There are many issues with this, which I can’t go into in a short book review, but what matters about this for women and alcohol is that women’s bodies just don’t biologically process alcohol the same way men’s bodies do. Sarah Hepola goes into this in quite some detail, but essentially, women get drunker faster on less alcohol than men do, which means women black out more easily, and blackouts are dangerous. They make anyone vulnerable, but they make women particularly vulnerable to things like date rape.

Sarah Hepola does a much more eloquent job in the book than I am doing here in the review of illuminating how gender and alcohol mix to make the modern alcoholic young woman. And the book doesn’t just detail the dramatics of her youthful drinking. She also goes into great detail about what it was like to stop. To find the empowerment of being completely in control again and not losing parts of herself and her life to blackouts. She talks about her sober life and how exciting it is, and she even talks about finding some spirituality. Most importantly to me, she discusses how women in western culture today are often told we are equal but are able to sense that things that are feminine are just not taken seriously. So they pursue the masculine to be taken more seriously and in some cases the masculine is simply not helpful. It is harmful. Sometimes, in cases like with binge drinking, it’s even more dangerous for women than for men. I believe the book offers some hope when Hepola talks about finding strength in her sober living and in her accomplishments at facing life as a single woman.

Those listening to the audiobook will be entranced by Hepola’s own voice telling the story. I couldn’t stop listening and listened every second I could. One of the more haunting moments of the audiobook is when toward the end Hepola introduces a tape recording she made as a teenager discussing a sexual encounter she had while drunk with a much older boy. Hearing the incredibly young voice of a woman already being drawn into the harmful world of addiction was heartbreaking to listen to and made me want to fix things, even though I wasn’t totally sure how.

This book left me realizing that the reality of women and alcohol has changed, and the cultural narrative needs to catch up with it. Women aren’t drinking in closets to dull their feminine mystique pain anymore. They’re drinking loud and proud because they want to be empowered and taken seriously and yes, even perceived of as cool. While we can talk about finding more positive ways of empowerment, I think it’s also important that we as a culture strive to stop putting innate positive value on the masculine and negative on the feminine. Things should be valued based on their impact on the world and not on the gender norm of who does it. And young women will stop feeling pressured to act like a man when men and women are equally valued. All of these things I am saying play into male drinking as well. If you think zero young men are binge drinking to be seen of as more of a man, you’re very wrong. We just see less of the immediate negative impact of male binge drinking because women black out so much more easily.

Hepola wrote a brave book that illuminates the issue of binge drinking among young women today. It’s both personal and with an eye to the culture as a whole, thinking beyond just the author herself. Readers will be haunted both by the voice of the young Sarah and by the thought of young women seeking to empower themselves actually making themselves more vulnerable. A key read for anyone who works with or cares about these younger generations of women.

Summary:
It may be difficult to describe a hoard, but you know one when you see one. Maybe you have a neighbor who keeps their shades drawn but when you enter their home you see piles and piles of stuff that either they keep for a project they’ll do one day or because every scrap of it contains important information (according to them). Maybe you’ve only encountered hoarding through reality tv shows focused around the forced clean-up of homes that immediately appear unlivable to you but yet that the person on the show insists is full of treasures. Or maybe you grew up in a home where the hoard slowly encroached on your own room

Between 2 and 5 percent of the population suffers from Hoarding Disorder. Frost and Steketee were the first to begin scientifically studying it. Here, couched in tales of real interactions with and homes of clients (who granted their permission to be featured in an anonymized fashion) Frost and Steketee present both what we know and what we don’t know about hoarding, as well as best practices for helping someone with the disorder.

Review:
As an outside observer of a hoard, it can often be difficult to imagine what leads a person to believe trash is treasure. But of course it’s more complicated than someone just being unable to recognize trash. After all…one man’s trash is another man’s treasure. The authors attack this head-on by first giving a true definition to what counts as hoarding and then talking about various causes and possible presentations of the disorder. So what counts as hoarding?

It hardly matters how much stuff anyone owns as long as it doesn’t interfere with his or her health or happiness or that of others….Hoarding is not defined by the number of possessions, but by how the acquisition and management of those possessions affects their owner. (page 58)

So basically, it counts as hoarding if the collection of items interferes with the person’s health or happiness or the health or happiness of others nearby. The complicated gray area of course is that the sufferer may not realize that the hoard is interfering with their happiness and health. That is the point of conflict for many loved ones of people who hoard.

After establishing and defining what hoarding disorder is and is not, the authors continue on to analyze the behavior and mind of someone suffering from hoarding. Fascinatingly, hoarding shares commonalities with many other mental illnesses, seeming to a certain extent to defy categorization, although the DSM 5 currently lists it among “Obsessive Compulsive and Related Disorders.” Are you shocked? Did you think that OCD always means cleanliness? The fact is that is often not what OCD means. It’s a misunderstanding spurred on by popular culture. OCD is an obsession. It can be with cleaning and germs but it can also be with anything. It also often features repetitive behaviors. If you think about it, you can see what hoarding has in common with this. People who hoard become obsessed with the idea of not losing something important, of collecting everything relevant to a certain idea, of not wasting things. They also can come to establish repetitive behaviors such as maybe always buying a newspaper from a certain store on the way home from work. Another similarity with OCD is that hoarders often are perfectionists. Part of why their homes become cluttered is they are obsessed with only doing a perfect job of cleaning up or of fixing something or using some item for a project, and they become paralyzed with the fear that they can’t do it good enough, so they never start.

The authors also talk about how hoarding has commonalities with Impulse-Control Disorders, such as gambling and compulsive buying. Many people who hoard also struggle with both of these ICDs, and it’s easy to see the relationship here. Similarly, many hoarders show symptoms of ADD. They often do much better cleaning up if there is simply someone there to help them maintain focus, rather than being easily distracted.

Hoarding is also often a result of trauma. People suffer a trauma and essentially attempt to build a protective space around themselves by hoarding.

Compared to people who do not suffer from hoarding problems, clutterers report a greater variety of traumatic events (an average of six versus three), as well as a greater frequency (an average of fourteen versus five) of such events. The type of trauma most often experienced by hoarders include having had something taken by threat or force, being forced into sexual activity, and being physically assaulted. (page 87)

Interestingly, there’s a comparatively low incidence of PTSD among hoarders, in spite of such a high incidence of trauma. (A 2006 study found only 6% of hoarders had PTSD, page 91). It is possible that hoarding prevents the development of PTSD. Many hoarders also report a childhood devoid of warmth and support, so even if they were not traumatized, it is still likely that they had a cold, distant childhood. In contrast to PTSD, the majority of hoarders (nearly 60%) meet the criteria for major depression, and it is posited that this depression could be in response to the hoarding itself.

People draw conclusions about their worth and competence based on their inability to control their living space, and not being able to entertain people in their homes isolates them and limits their social lives. (loc 532)

The authors then talk about what may be going on in the heads of people who hoard. People don’t do things completely irrationally. There are reasons for it. There are multiple possibilities for hoarding of what may be going on. No single aspect has been determined yet. However, in general, hoarders suffer from a different type of threat signal. They fear something being removed, rather than the presence of something. It has also been posited that they have the opposite of claustrophobia. They feel safer in small, tight spaces, so they artificially create them. Hoarders also frequently struggle with identity. Rather than knowing who they are, they often are defined by the question “Who am I?” and collect items to try to show who they are. In addition to the aforementioned perfectionism, hoarders also seem to view items differently from the rest of us. They are generally very optimistic about future usefulness and can be quite creative as to reusing things. It has been posited that hoarding may be creativity run amok. However, many hoarders also gamble compulsively and the relationship between a hoarder’s positive thinking and a gambler’s is interesting.

“Seeing the scratch tickets over the counter at the convenience store leads me to think, One of those tickets is surely a winner, maybe a million-dollar winner. How can I walk away when the opportunity is there?” Our hoarders have said similar things about items they’ve wanted to acquire. (loc 202)

Distress avoidance is also often a common feature. Distress avoidance is when a person seeks to avoid a situation that they think will cause them distress. They then build up that situation in their heads to be more of a stressor than it actually would be. Continual avoidance of these types of situations also weakens a person’s ability to deal with them (due to lack of practice), so it’s a bit of a self-fulfilling prophecy.

Animal hoarding is its own special subcategory, and it seems that in addition to all of the other possible hoarding issues, animal hoarders may suffer from a form of an attachment disorder where their bonds with other humans are frayed and easily broken and replaced by bonds with animals.

So, essentially, hoarders are often people who are perfectionists who tend to perform rituals and struggle with impulse control. They may compulsively shop and/or gamble in addition to hoarding. They often had cold, distant childhoods and/or suffered a trauma (or traumas). They tend to come at life from a basis of fear and feel safer in tight, closed spaces, and their fear is heightened by removal of things, rather than appearance of new things. At some point, they started avoiding distress, and this distress avoidance became a self-fulfilling cycle. They also frequently struggle with knowing who they are internally, rather looking outward to possessions for identity signals. In addition to these compulsions and fears, hoarders also often see things differently or in more detail than non-hoarders, and they also struggle to focus or concentrate, making cleaning up even more difficult for them.

The authors conclude by discussing both how to treat hoarding and effects on family members and loved ones (as well as on communities). The authors stress repeatedly that forced clean-ups are the absolute worst possible solution or treatment option. A forced clean-up just fulfills the person’s fear that people are out to get them, and simply makes them cling on to their possessions even more aggressively. It also can make them more depressed. Since their identity is wrapped up in their possessions, getting rid of them by force can cause emotional trauma akin to someone chopping off your hair by force. I was stunned to learn that there have been cases of people who hoard committing suicide after a forced clean-up. The authors strongly advocate for the much slower, but with more long-term positive results, method of going through the hoard with the person slowly and basically teaching them new ways to think about both their possessions and their identity. They also state that it’s easier to treat compulsive buying and gambling than hoarding, so when possible treat that first to prevent the arrival of new items into the hoard. It is a long, difficult treatment plan to go through a hoard slowly, and sometimes it may be necessary to remove the person from the home for safety but then to return with them repeatedly to work on cleaning out the hoard.

The fact that forced clean-ups are the worst possible solution for the sufferer and the fact that hoards get worse over time leads me to believe that early interventions are absolutely critical to render the most help to those suffering from hoarding. But this is a complex thing. Since many cases of hoarding start due to a cold home environment or from trauma, it may be difficult to get parents behind addressing the situation early. Many people who hoard interviewed in the book talk about their hoarding beginning to get out of control by late in their freshman year of college. Perhaps this is something colleges should be keeping an eye out and offering help for. Additionally, shame is often mentioned as a factor in keeping the problem hidden. Perhaps PSAs and other public service campaigns could both lessen the stigma and offer help to people early on in the development of a hoard.

So much of hoarding is stigmatized. To a certain extent this is understandable. It often isn’t seen by the public until it has reached a public health crisis level or in situations where animal hoarders are keeping their hoards in deplorable conditions. Often loved ones of those who hoard feel trapped and frustrated by the hoarding. They feel as if the loved one loves their stuff more than them. These are complex issues and professional help is required to address them. I honestly don’t think this is a situation that is easily handled one family at a time. A family member must be well-informed and patient and empathetic enough to wait through the long treatment process. Often that family member is the child of the hoarder and therefore a minor with no power, which makes the issue even more complex. This is definitely a situation in which public health education campaigns on things like early warning signs of hoarding tendencies and ways to seek help could be extremely helpful long-term. I do believe the authors could have taken things one step further at the end of the book to this connection to public health, rather than mostly focusing on individual therapy. They do mention less consumerism would be helpful, but that simply is not much of an observation. It is a small complaint, but I do feel that this interdisciplinary leap is important.

Overall, this was a fascinating, enlightening book. The authors have conducted extensive scientific research for years, and they do an awesome job of writing this information at the consumer level, as well as humanizing it by bringing in real cases with clients who they render in a three-dimensional fashion. I know I for one will never be able to stomach watching forced clean-ups on the tv show “Hoarders” again. Recommended to really everyone. Anyone could potentially know someone who struggles with hoarding, whether now or in the future, and the book is very readable.

Featured Quote

"Is all very well thinking everything is going to be different when you come back but then it is all the same. Suppose I have to make it different."
--Bridget Jones: The Edge of Reason by Helen Fielding